Provider Demographics
NPI:1063809697
Name:APTECKER, MARISA CASSANDRA (DC)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:CASSANDRA
Last Name:APTECKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 W 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-5104
Mailing Address - Country:US
Mailing Address - Phone:541-736-6899
Mailing Address - Fax:541-967-7844
Practice Address - Street 1:943 GEARY ST SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-4904
Practice Address - Country:US
Practice Address - Phone:541-967-7844
Practice Address - Fax:541-967-7844
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5641111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor